— When emergency responders reach a gunshot or stabbing victim, they
try to immobilize the spine to reduce the danger of paralysis upon
movement of the victim. That effort, however, can have a fatal toll.
A study published in the
has found that, among these types of trauma victims, those whose spines
are held still are twice as likely to die as those whose spines aren’t
immobilized.
Time is the crucial factor, said the study’s lead author,
“For someone who was shot in the liver or has a collapsed lung,” Haut
said, “those extra five minutes might mean life or death for them.”
The study cuts to the heart of a debate among trauma
surgeons about the roles of paramedics and other first responders, says
Dr.
Emergency Medicine Center. Many feel that time spent treating the
patient in the field is often better spent on the operating table.
Immobilization is “a tradition that started decades ago,” says Dr.
First responders typically fasten a cervical collar
tightly around a victim’s neck and then strap him or her to a plastic
board to secure the spine. This takes time, and it can hide or
exacerbate internal injuries.
The likelihood that the spine would be injured by a
penetrating wound is pretty low, Baraff added. “Unless the bullet hits
the spinal column in exactly the right way, it’s extremely unlikely
there’s going to be an unstable spinal column,” Baraff said.
In the new report, out of the more than 45,000
patients studied (about 2,000 of whom underwent spine immobilization),
only 30 had some partial damage to the spine that may have benefited
from the procedure. First responders would have to immobilize the
spines of 1,032 patients before potentially benefiting one person, the
study’s authors wrote. But it only took 66 patients to potentially
contribute to one death.
The best thing to do is get a patient to the
hospital as fast as possible, doctors said — the cervical collar
usually serves no purpose other than to get in a surgeon’s way.
“We remove it immediately,” Demetriades said.
“We say to the paramedics, ‘Thank you very much for
taking care of them, you did a great job,’ and immediately take (the
collars) off and throw them away.”
—
(c) 2010, Los Angeles Times.
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